Provider Demographics
NPI:1598034951
Name:BRTQL8 INC
Entity type:Organization
Organization Name:BRTQL8 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:859-588-3709
Mailing Address - Street 1:105 WINDSOR PATH
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9617
Mailing Address - Country:US
Mailing Address - Phone:859-588-3709
Mailing Address - Fax:502-603-0622
Practice Address - Street 1:105 WINDSOR PATH
Practice Address - Street 2:SUITE 3
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9617
Practice Address - Country:US
Practice Address - Phone:859-588-3709
Practice Address - Fax:502-603-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000745303OtherANTHEM
KY50071614OtherPASSPORT
KY7100279260OtherEPSDT SPECIAL SERVICES
KY7100270990Medicaid
KY7100270990Medicaid